Tuberculosis among Public Sector Healthcare Workers in eThekwini District; KwaZulu-Natal

Background: South Africa has one of the highest burdens of tuberculosis globally. Transmission of tuberculosis in health-care settings is common and healthcare workers face an increasing threat of becoming infected. Objective: The aim of this study was to calculate the incidence of tuberculosis reported among healthcare workers in public sector hospitals and clinics within eThekwini Health District in KwaZulu-Natal; South Africa; from 2006 to 2010. Methods: A retrospective review of tuberculosis registers at occupational health clinics was conducted in 11 hospitals andfour community health centres in the District. All healthcare workers who were diagnosed and treated for tuberculosis at these facilities were included in the study.Results: Six hundred and eighteen healthcare workers were diagnosed with tuberculosis during the study period; a total of 67 562 healthcare workers were employed. The mean incidence of tuberculosis over the study period was 908 cases per 100 000 (95% CI 771 - 1 046). The incidence of tuberculosis in healthcare workers was higher than that in the general population but lower than in the provincial and district populations. Conclusion: Tuberculosis among healthcare workers remains an important occupational health issue. The high burden of tuberculosis in KwaZulu-Natal; and under-reporting of tuberculosis among healthcare workers are likely to have masked the high incidence among healthcare workers

Healthcare Waste Management in Clinics in a Rural Health District in KwaZulu-Natal

The handling of healthcare waste (HCW) was investigated in 30 rural healthcare facilities in KwaZulu-Natal. Using a semi-structured questionnaire; interviews were carried out with the person in charge of the facility and observations were made to establish current practices in sorting; handling and disposal of HCW. It was found that improper sorting and management of HCW occurred on most sites with implications for cost; infection control and education. It is imperative therefore that improved HCW management measures be implemented and that healthcare facility staff receive appropriate and repeated training to ensure minimising risk

Using Lot Quality Assurance Sampling Methodology to Evaluate the uThukela District Child Survival Project of KwaZulu-Natal

Health services programmes and interventions require objective measures on coverage and quality to ensure that managers have the evidence to adopt and expand health interventions effectively and efficiently. Over the past 15 years; the uThukela District Child Survival Project of South Africa achieved this through regular two- to three-year project evaluations using cluster sampling. Results of these surveys have improved the ability of Child Survival Projects to identify priorities; define objectives based on data; and measure progress towards these objectives. However; the inability to disaggregate information to composite Supervision Areas (SAs) was a limitation. Lot quality assurance sampling (LQAS) was adopted as an improved method based on its ability to assess performance in disaggregated units within a study population and to reliably compare coverage and health status indicators for routine monitoring of child survival activities. This study assessed the feasibility and reliability of LQAS to evaluate the Child Survival Project and compare the results of a rapid manual analysis with a secondary electronic analysis of the same data. The accuracy of the manual analysis was comparable and provides evidence that LQAS and rapid manual analysis can be used to evaluate intervention programmes; particularly in settings of limited electronic technology and expertise

Cervical Cancer Screening in Urban Clinics in eThekwini Municipal Area

Cancer of the cervix is a significant burden on women's health throughout the world despite it being a largely preventable disease. In South Africa; the launch of the National Guideline on Cervical Cancer Screening in 2000 aimed to reduce the incidence of cervical cancer in the country. The aim of this research is to review the status of cervical screening in clinics of eThekwini municipal area in Durban; KwaZulu- Natal; South Africa. A cross-sectional; descriptive study of clinics involving 22 nurses working in fixed clinics offering cervical screening in the eThekwini municipal area was carried out. Interviews were conducted with professional nurses from the clinics using a semi-structured questionnaire. Questions focused on the availability of resources to implement cervical screening; nurses' knowledge; attitudes and beliefs towards cervical screening. Interview data were verified and complemented by direct observation of screening facilities. The equipment in the clinics was always adequate for taking cervical smears. No patient education material was available to promote cervical screening or provide information about cervical cancer. The median number of women screened was 20 per month in accordance with a quota system currently in place. When given a hypothetical cytology result to interpret; 27of nurses identified the correct management regimen; 64recognised that they needed more training in the interpretation of cytology results. Most cervical screening in the clinics was done for diagnostic reasons rather than as population-based screening. Barriers to effective cervical screening included: insufficient nursing staff; a quota system limiting the number of smears that could be taken and inadequate patient educational material on cervical cancer